卡维地洛在心力衰竭合并慢性阻塞性肺疾病或哮喘患者中的耐受性

Tolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma.

作者信息

Kotlyar Eugene, Keogh Anne M, Macdonald Peter S, Arnold Ruth H, McCaffrey Dermot J, Glanville Allan R

机构信息

Cardiopulmonary Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales 2010, Australia.

出版信息

J Heart Lung Transplant. 2002 Dec;21(12):1290-5. doi: 10.1016/s1053-2498(02)00459-x.

DOI:10.1016/s1053-2498(02)00459-x

PMID:12490274

Abstract

BACKGROUND

A substantial proportion of the population with congestive heart failure (CHF) has concomitant airway disease. Little information exists on the tolerability of carvedilol in patients with chronic obstructive pulmonary disease (COPD). In this study, we assessed the tolerability and efficacy of carvedilol in patients with CHF and concomitant COPD or asthma.

METHODS

Between 1996 and 2000, a total of 487 patients began receiving open-label carvedilol. Forty-three (9%) had COPD (n = 31) or asthma (n = 12). Spirometry supported clinical diagnosis in all, and full pulmonary function testing supported diagnosis in 71%. Sixty percent began carvedilol therapy in the hospital and underwent measurement of peak expiratory flow rates (PEFR) before and after dosing.

RESULTS

In patients with COPD, mean forced expiratory volume in one second (FEV(1)) was 62% +/- 13% predicted, reversibility was 4% +/- 4% with bronchodilators, and FEV(1)/FVC was 62% +/- 8%. Mean PEFR was 325 +/- 115 liter/min before the dose and increased by 17% 2 hours after the carvedilol dose (p = 0.04). In patients with asthma, mean FEV(1) was 80% +/- 17% predicted, reversibility was 13% +/- 7%, and FEV(1)/FVC was 74% +/- 11%. Mean PEFR was 407 +/- 161 liter/min before the dose with no significant change 2 hours after the dose. Carvedilol was introduced safely in 84% of patients with COPD, with only 1 patient withdrawn from therapy for wheezing. In contrast, only 50% of patients with asthma tolerated carvedilol. Survival at 2.5 years was 72%. In survivors, left ventricular end-diastolic diameter decreased from 76 +/- 11 mm to 72 +/- 14 mm (p = 0.01), left ventricular end-systolic diameter decreased from 65 +/- 13 mm to 60 +/- 15 mm (p = 0.01), and fractional shortening increased from 14% +/- 7% to 17% +/- 7% (p = 0.05) at 12 months.

CONCLUSIONS

Patients with CHF and COPD tolerated carvedilol well with no significant reversible airflow limitation, but patients with CHF and asthma tolerated carvedilol poorly. The effect of carvedilol on left ventricular dimensions and function in patients with concomitant airway diseases was similar to that seen in our general group of patients. Asthma remains a contraindication to beta-blockade.

摘要

背景

相当一部分充血性心力衰竭（CHF）患者合并气道疾病。关于卡维地洛在慢性阻塞性肺疾病（COPD）患者中的耐受性信息较少。在本研究中，我们评估了卡维地洛在CHF合并COPD或哮喘患者中的耐受性和疗效。

方法

1996年至2000年间，共有487例患者开始接受开放标签的卡维地洛治疗。其中43例（9%）患有COPD（n = 31）或哮喘（n = 12）。所有患者的肺活量测定支持临床诊断，71%的患者通过全面肺功能测试支持诊断。60%的患者在医院开始卡维地洛治疗，并在给药前后测量呼气峰值流速（PEFR）。

结果

在COPD患者中，一秒用力呼气容积（FEV(1)）平均为预计值的62%±13%，使用支气管扩张剂后的可逆性为4%±4%，FEV(1)/FVC为62%±8%。给药前平均PEFR为325±115升/分钟，卡维地洛给药2小时后增加了17%（p = 0.04）。在哮喘患者中，平均FEV(1)为预计值的80%±17%，可逆性为13%±7%，FEV(1)/FVC为74%±11%。给药前平均PEFR为407±161升/分钟，给药2小时后无显著变化。84%的COPD患者安全地开始使用卡维地洛，只有1例患者因喘息退出治疗。相比之下，只有50%的哮喘患者耐受卡维地洛。2.5年时的生存率为72%。在幸存者中，左心室舒张末期直径从76±11毫米降至72±14毫米（p = 0.01），左心室收缩末期直径从65±13毫米降至60±15毫米（p = 0.01），12个月时射血分数从14%±7%增加到17%±7%（p = 0.05）。